Provider Demographics
NPI:1083783336
Name:HUSMAN, RONALD MEREL (SFIDC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MEREL
Last Name:HUSMAN
Suffix:
Gender:M
Credentials:SFIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10705 130TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-8878
Mailing Address - Country:US
Mailing Address - Phone:360-657-5473
Mailing Address - Fax:
Practice Address - Street 1:USS FORD FFG 54
Practice Address - Street 2:ATTN MEDICAL DEPARTMENT
Practice Address - City:FPO AP
Practice Address - State:WA
Practice Address - Zip Code:96665-1508
Practice Address - Country:US
Practice Address - Phone:425-304-5204
Practice Address - Fax:425-304-5202
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians